Acceptance and feasibility of a low-threshold and substitution services-based periodical monitoring system for blood-borne and sexually transmitted infections among people who inject drugs in Germany: a mixed-methods analysis

Background To reach the global elimination goals of viral hepatitis B and C (HBC, HCV), human immunodeficiency virus (HIV) and other sexually transmitted infections as a public health threat by 2030, monitoring is needed. Staff members of drug services and opioid substitution treatment (OST) practices in Berlin and Bavaria recruited clients for a pilot study addressing the respective infections among people who injected drugs (PWID) in Germany, 2021/2022. Participants filled a questionnaire and were tested for HBV, HCV, HIV and syphilis using dried blood spots (DBS). We evaluated the study design to implement a feasible and accepted nationwide periodical monitoring among PWID and serve as an example for the implementation of similar monitoring systems in other countries. Methods A mixed-methods design was used, including focus group discussions with study participants and staff members and a semi-quantitative questionnaire filled by the latter. Aspects covered were the setting for recruitment, study preparation for staff members, willingness of clients to participate, the study questionnaire, blood collection and return of results. Results The majority (96%) of 668 study participants were recruited in low-threshold services, drug consumption rooms and OST-practices. Flexibility of recruiting study participants during routine work or testing weeks/days was important to the facilities. Collaborations with local AIDS services helped cope with the work load of data collection. The need to train staff for DBS collection was highlighted. Study participants welcomed the testing opportunity in familiar places. Study participants frequently needed assistance to complete the study questionnaire. Return of results was considered as ethically mandatory by staff members but referral to treatment remained challenging. Conclusions For a successful monitoring time flexibility and adequate training are essential. Individual benefits for study participants by receiving their test results should be ensured and referral networks with infectiology practices may increase number of infected PWID receiving treatment. Overall, the evaluation confirmed that a monitoring through drug services and OST-practices is feasible and well accepted in Germany. Beyond that it shows important lessons learnt for the implementation in other countries. Supplementary Information The online version contains supplementary material available at 10.1186/s12954-024-00977-0.

Introduction of the organisation: How many employees does your organisation have?How many were involved in the study? 1) Why did your organisation take part in the DRUCK study?
2) What are your experiences?

What worked well?
Where were the hurdles?
The following points and aspects can also be asked specifically during the interview: a. Recruitment & information i.Is the location/facility suitable for recruitment?
ii.Is the location suitable for implementation?b.Questionnaire i. Length?
ii.Too private?
iii.Completed alone/assisted?c.Language mediation (Language mediation was welcomed at the beginning, but has not been used so far.As this service is very expensive, it would be important for us to know why not).
i. Need?
ii. Hurdles to utilisation?
iii.Attempt but problems with accessibility? d.Testing i. Inhibitions during blood sampling?
ii.Too many spots on the cards that need to be dripped?e.Return of results, if applicable i. Could the results be returned?
ii.How time-consuming was this? (Documentation contact list, presence of doctor) iii.In the case of rapid testing: How did the post-test counselling go? f.Transfer to treatment: i. Are there contacts for referral?
ii. Were participants who tested positive successfully referred?g.If applicable, from the participants' point of view?i. Were there any hurdles on the part of the participants that you are aware of?
ii.Or aspects of the study that the participants found good or bad?
If it is not addressed anyway, the study programme for the months of October -April could also be addressed here: Did you feel well prepared? ii.
Which areas need more preparation? iii.
Were you able to remember the content you needed even after a long time?To what extent did this model work? iii.
Which model do you think makes more sense?
e. Cooperation partners (only applies to organisations with cooperation partners) i.
Which tasks were taken on by which partners? ii.
How helpful was this for the realisation of the study? iii.
Would such co-operation also be conceivable in the future?iv.
Would it be possible to carry out the study without this cooperation?ii.Comprehensibility?
iii.What could be helpful when completing the questionnaire?iv.Do you think it makes sense for participants to complete the questionnaire on their own?c.Testing i.Once again the fundamental question: Should results be returned or not?
ii. Would a quick test be an adequate alternative for returning results?
iii.How many drops are realistic?(13 drops were required in Bavaria, 17 drops in Berlin) d.Return of results i. Follow up on the previous and general question on the return of results.
ii.How could participants be better reached for the return of results?
iii.What could be improved for the post-test counselling (as mainly institutions from study arm 2 will be there)?
e. Study preparation/training i. Would it also be conceivable to carry out the study preparation independently online (videos)?
ii.What would the study preparation ideally have to look like for the institutions so that it is feasible in terms of time and personnel?
iv.Was the refresher meeting in January helpful for the rest of the recruitment period?b.Study implementation and possible changes over Christmas i. Have the conditions for conducting the study in your organisation changed over the period of the study?ii.How useful do you think the winter months are for conducting the study?c.Extension (April) i.To what extent was the extension of the recruitment period in April helpful for you?d.Continuous testing vs. test week models i.How did you plan the implementation in your organisation?ii.
on your current experience, to what extent do you think monitoring ... a. ... makes sense?b. ... is feasible?6) What would monitoring have to look like for it to work?If no ideas come up, go through the following points or work on the previously mentioned aspects/hurdles and find possible improvements.a. Recruitment & education i.Where and how can potential study participants be reached and recruited in the best possible way?b.Questionnaire i.How long should the questionnaire be?